Co-beneldopa (Madopar): Parkinson's medicine explained

Co-beneldopa treats the main symptoms of Parkinson's disease: tremor, slowness and stiffness. It contains levodopa together with benserazide. The NHS says the two ingredients work together to help the brain and muscles communicate, restoring more normal control of movement.

It does not help with non-movement symptoms such as low mood or loss of smell, according to the NHS. It is prescription-only, and Madopar is the brand named on the NHS page.

Three formulations exist. Standard capsules are swallowed whole with water and should not be broken, crushed or chewed. Slow-release capsules are absorbed gradually and so are taken less often. Dispersible tablets are put in a small glass of water, where they break up quickly and turn the water white, which suits people who find swallowing difficult.

Doses are individual. The NHS says treatment starts low and is raised gradually until symptoms are controlled, with the aim of the lowest dose that works to keep side effects down.

Keeping to the same times each day is described by the NHS as important for symptom control; if doses are delayed, symptoms may return. Protein can interfere with absorption, so the advice is to avoid taking the medicine with high-protein meals such as meat, eggs, cheese, beans and lentils.

The practical rule given is to take co-beneldopa at least 30 minutes before a meal or 60 minutes after one. If you miss a dose, skip it and carry on with the normal schedule. Never take extra to catch up.

The NHS says you will usually feel co-beneldopa start to work after the first dose, but it can take up to 3 weeks to feel the full effect. It does not say how long treatment lasts, and as Parkinson's is a long-term condition it is typically an ongoing medicine reviewed by the specialist team.

Common effects include loss of appetite, nausea and vomiting, taste changes, dizziness, difficulty sleeping and involuntary movements called dyskinesia. For nausea the NHS suggests a low-protein snack with the dose. For dizziness, get up slowly and avoid driving, cycling and alcohol. For poor sleep, avoid heavy evening meals, smoking and caffeine.

Dyskinesia should be reported to the doctor or specialist nurse as soon as possible, because the dose or medicine may need adjusting. Harmless colour changes in saliva, the tongue or the mouth can occur.

Call 111 or the doctor for unusual thoughts, hallucinations, mood disturbance, recurring infections or bruising, fainting, uncontrolled impulsive behaviour or excessive sleepiness. The NHS says to call 999 or go to A&E for gastrointestinal bleeding, an irregular heartbeat, thoughts of self-harm, chest pain, severe breathing difficulty, seizures or anaphylaxis.

Most adults aged 25 or over can take it. The NHS asks you to tell your doctor if you have had an allergic reaction to it, have glaucoma, depression or psychosis, or a history of melanoma or suspicious moles. Other points to mention are stroke or heart attack, heart rhythm problems, stomach ulcers or bleeding, diabetes, an overactive thyroid, Cushing's syndrome, and liver, kidney or adrenal gland problems.

Co-beneldopa can also affect the results of blood and urine tests, so tell anyone arranging them that you take it.

The NHS names MAOI antidepressants (tranylcypromine, phenelzine, isocarboxazid), anti-sickness medicines (domperidone, metoclopramide, prochlorperazine), some antipsychotics (amisulpride, aripiprazole, haloperidol, risperidone), and blood pressure medicines such as atenolol, ramipril and amlodipine. Iron supplements, antacids, antihistamines, other antidepressants, bladder medicines and opioid painkillers are also listed.

Paracetamol and ibuprofen are generally safe, according to the NHS, and there is not enough information to say herbal remedies are safe with it.

It is rarely prescribed in pregnancy because of limited safety data, though a doctor may advise it if the benefit outweighs the risk. Breastfeeding may be acceptable for a healthy baby after discussion; small amounts pass into milk and it can occasionally reduce milk supply. There is no evidence it affects fertility.

Do not stop suddenly. The NHS warns that sudden stopping risks serious withdrawal with stiff muscles, fever and confusion, so the doctor reduces the dose gradually. For overdose, call 999 or go to A&E for a fast or irregular heartbeat or signs of internal bleeding, and use 111 if you have no symptoms. Do not drive yourself.